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Next stop: the top. In the meantime, Cyndie Miculan,
MSN, RN, is honing her skills and thoughts on nursing,
leadership and education as a relatively new nurse manager
in Greenville, N.C.
Miculan, a manager for a little more than two years,
began July 1 as head of the family medicine floor at
Pitt County Memorial Hospital. It's the next step in
a career that will have taken her from a later-in-life
diploma nurse to earning bachelor's and master's degrees
and now-she hopes-to health care administration.
A desire to understand the business of nursing spurred
her to an advanced degree and the mastery of once-daunting
concepts, such as the origin and application of statistics,
for instance, in the allocation of resources. Miculan
said she's found that management is filled with the
nuts and bolts of departmental budgets, hiring, scheduling
and performance evaluations, but the most rewarding
part is mentoring and guiding.
"A lot [of the] time as managers, we're just a
support person," she said. That's how she views
herself-as a leader.
Miculan formally teaches a basic life-support course.
Informally, through mentoring, she teaches her RNs self-preservation
as they care for patients with chronic conditions: sickle
cell anemia, the effects of stroke, amputations and
nursing home residents on the decline.
Nurses on the family medicine floor are young enough
that they have yet to experience burnout, Miculan said,
and with mentoring she would like to help them avoid
it forever.
The burnout she occasionally witnessed as a staff nurse
in Akron, Ohio, "came from people who wanted to
do it all themselves, who had the typical type A personality:
We want it done now, we want it done right and we want
to do it," Miculan said. While those are the utterances
of good nurses, "it's also a recipe for self-defeat,"
she said. "It's not necessary that they do everything
by 9 o'clock in the morning. It's not necessary that
they do everything today. And it's not necessary that
they themselves have to do it all. That's a hard thing
for nurses."
Miculan said that accepting the slow pace of change,
whether it's staff learning to delegate and prioritize
or enhancing the delivery-of-care system, is among the
more difficult things for her to do as a manager.
"I was thinking I could walk in and say, 'I'm
going to do something' and actually do it. But in the
real world, it needs to go through a lot of committees
and decision-makers," she said. For example, "to
tweak that care delivery system, which could mean the
mix of professionals and nursing assistants or actually
how the jobs are divided out, it goes through a lot
of channels before it can be changed. It's not enough
to walk in and say, 'OK, we're going to try this.' I
wasn't prepared for the time lag."
Nor was she prepared for the expense of a nursing education
that, for lack of money, she put off until she had married,
run a bakery for 20 years and reared two children. "Between
my student loans and the student loans of my children,
I don't know that I'll ever be able to retire,"
Miculan, 48, said. "But advanced education is an
important asset."
She said she's "a little uncomfortable" that
North Carolina does not require continuing education
of RNs.
Ohio, where she began her nursing career in 1993, is
one of 29 states and the District of Columbia that requires
continuing education credits or a minimum number of
hours of practice for license renewal. The others are
Alabama, Alaska, Arkansas, California, Delaware, Florida,
Iowa, Kansas, Kentucky, Louisiana, Massachusetts, Michigan,
Minnesota, Nebraska, Nevada, New Hampshire, New Mexico,
New York, North Dakota, Oregon, South Carolina, South
Dakota, Tennessee, Texas, Utah, West Virginia and Wyoming.
Of the states without a continuing education component
for RNs, seven do require it for re-licensure of advanced
practice nurses: Georgia, Hawaii, Idaho, Maine, Mississippi,
New Jersey and Washington.
"I think nurses, as a professional obligation,
need to continue their education. I feel they need refreshers
every year and there should be some way of measuring
it," Miculan said.
Besides asking RNs to encourage family and friends
into nursing, where there are a thousand directions
to go, all starting with the same basic skills, the
importance of education is Miculan's pet message. "Go
back to school," she said. "Go for it."
Contact
Phil McPeck at getpjm@aol.com.
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